MEDICARE: LCLJ OPTICAL CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	006929	NY

General Provider Information

NPI Number	:	1841594561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LCLJ OPTICAL CORP.

Provider Business Mailing Address
First Line	:	240 PAGE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1170
Country	:	US
Telephone Number	:	718-227-4059
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 PAGE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1170
Country	:	US
Telephone Number	:	718-227-4059
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / OPTICIAN
Name	:	MR. LOUIS SOLOMON
Credential	:
Telephone Number	:	718-227-4059

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	08/02/2011

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Directions to “LCLJ OPTICAL CORP. ” Practice Location

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